14703 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION � � li
JOB INSPECTION RECORD 1'
PERMIT EXPI9ATION
, . JOB ADDRESS_p-7�/ -•vV�+'<�✓ �/ UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTE ACTOR0 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOR - teo onus OF PERMIT Issu-
FOUNDATION . - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED r
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY.OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _ -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED j^31-$$ - '•� r -�
UNDERGROUND /SLAB - O k _ LpL C " �TXIG
•
PLUMBING
ELECTRICAL '
ISSUANCE DATE
MECHANICAL .jOP•. bLOG ELECT PLG. MECH.
�f C�Pe ] ❑ ❑ D
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y,',• - BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION SrFT.
� - �.:
MECHANICAL -
ELECTRICAL PENAllT TO -
FRAMING'
INS LATIONSTORIES TYPE CONSTR.
-
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.FT.FLoaN area TOTAL ACR EACL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
_}. BUILDING USE
ROOF SHEATHING RES INTI CON Pe oln.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED • FINALS DATE INSP. ❑ '❑ ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH SAN.#
PLUMBING - ELECT. ENERGY '
TRACT NO. PARC[L NO.
TUBS&SHOWER PAN �� PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
ELECTRICAL �,Qq�' BUILDING ENERGY . ACC.DATE ACC.FILE NO,
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
' INSULATION PLUMBING
GAS TEST - GAS
' FIRE SPHINK ENERGY T-24MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' - Y F] NL]- .� ° o' NE]
'h!
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD/ONE AL U.C.
' INTERIOR SHEAR FIRE DEPT.
❑ N❑ Y L_ N❑.
SHEETROCK - . GRADE. FEESUMMARY
EXTERIOR LATH BUILDING'
INTERIOR LATH97
TEMPORARY APPROVALS - • A3ILDING
SCRATCH COAT ELECTRIC PCAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY. - SEISMIC FEE T�,:'
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC >/
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
�
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION.DATE — MECHANICAL
IMPORTANT! CONST.TAx .
PLEASE'READ REVERSE SIDE BEFORE
CALLING FOR .FINAL INSPECTION: TOTAL
OFFICE COPY,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
e r ~ BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
BUILDIRc - APPLICATION & PERMIT r� O^
ADDRESS r .,• I 3
/�L�• -'ELECTRICAL-
OWNER'S PLAN CHECK VALIDATION
i° "AME ��� -3
OTY ELECTRIC PERMIT a FEE -
ONE
CONTRACTORS
NAME r� OUT LETS-SWITCHES
-RECEP 10.00/1.00 � -
in NoLIGHTING FIXTURES 10.00/1.00
syC CON ADDHECS. PPLIANCES-RESIDENTIAL 4.00
10 NONE J/ -03 - PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT PANELS (OVER 200 AMP) - 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.
OR ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
0
ZIP TEMP. METERORPOLE.INS. 20.00 - -
APPLICANT'S q
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 31 �W�/�-/`-J
e ¢ i P1iw
F o O LICENSIi1)CONTRACTORS DECLARATION
au� 1 hereby affirm Ihm I am licensed under provisions of.Chapter 9 1 -
z w ARD a ISSUANCE DATE
G a a (emmmicoisC With Section ]000)of Di 11f 3,of the Business and _ nB0D0. ,.ECECTJ /sPLG. MECH.
H w i License
io las I my license is in(u 11 for and uL(• L s' 1gQC� -
oi y Wk License Class �Lic.Number / 7
H m H J Date!-_f1�_L2�Contmc90 , � - ��__f^❑
- IRO ""J.'BUIL'DING PERMIT
¢ ¢ w a OWNER-tlUIhDHR DECLARATION - .. . wt,CnOBff
U INFORMATION
X
; y I hereby affirm that I am exempt from the Contractor's License MISC.- � b1L7 `REFER TO ORD
a_o j Law for the following reason.(Sec.7031.5,Business and Professions a VALUATION S/FT.
- PERMIT ISSUANCE 10.00
Code:Any City or county which mquims a permit to construct,alter.
¢ improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTR. LIC.NO. ELEC. , / `l
O ¢ requires the applicant for st Lh pumtil to file a signed statement Ihal TOTAL
w he¢ PERMITO
licensed pursuant to the provisions of the Contractor's License '
R z i Uw(Chapter 9(commencing with Section 7000)of Division 3 of the �/IfTG37Z�l�x�, E�O 'L
3 ¢ o Business and Professions Codd or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
re r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n i by any'applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do Thee Work,and the structure is not . .
OCC.GROUP -RES.UNITS
intended or offered for sale Bac. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 SG FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such impro v-
mentsarenolintendedorofferedfor sale.If,however,the building GAS-EA.SYSTEM:11NC.4 OUTLETS 6.00
or improvement Is sold within ane year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). RESINDUSTRIAL WASTE INTER. 30.00 ❑ I❑ ❑N ❑ pO_
❑ L c owner of the property,he exclusively S, contracting with
licensed camas Cod m construct the pricense La 7044,or applss LAWN SPRINKLERS- 1 INC 6 V.B. 6.00 ASSESSORS PAR CEL NG.
and nProfessions grope The Contractor's License Law dues nn apply
to t,owner of property who builds or improves need p.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Cont for is projects with a conrracrorts)licensed pursuant ro -
rnc 1dF1 exempt
License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. . PARCEL NO.
reason WATER um exempt mnder See,-,B.&P.C.for this WATER HEATERaW/VENT• 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPBNSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm Ihut I have a certificate of consent to self-insure.
or a cee'liificate of Work�err,Compensation Insurance,or a certified ZONING ENG.SITE.NO.
XIcy(k(o�-I �3 Rylr.
❑ Certified py ls( reby Punished. ' FIRE SPRINK ENERGY T]4
Z = ❑ Cerlil opy is -c wi the city pection division.
O ADPIica MISC.- REFER TO ORD. Y❑ N v ❑ NEI
cc: 0 CERTIPICATIi OP I X17,MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL O (This Section need not be completed if the permit is for one. TOTAL Y❑ No , Y 0 N
2 hundred dollars IS 100)or Is.)
U O 1 certify that in the tsed.nmwme of the work for which thisparr- O.ry MECHANICAL PERMIT FEE FEE SUMMARY
LL H Fair is issued,I hall not employ my person in any manner so as m
❑ become subject to the Workers'Compensation Laws of California.
U a DateApplicant - ALTER OR ADD TO MECH. 5.00 BUILDING Q .��
} w NOTICE 10 APPLICANT: If,after making this Certificate of Ex-
�.. ? emptioa,you should became subject m the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR_HANDLING UNIT ITO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,0MC.F.M.) 6.00 -1 SEISMIC FEE e9'�
I hereby affirm that there is a construction lendinC agency for EXHAUST HOOD(WITH DUCT) 5100 ,�f.
the performance of the work for which this permit is iswd(See. Os MICROFILM
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.0_0 vj
Lender's Name -. ��LECTRIC
Leader's Address HEATING UNIT(OVER 100,000 B.T,Usl B:50
1 certify that 1 have read this application and state Ihaf the above VENTILATION FAN (SINGLE) s. 4.00 s .,1.w1\
information is rorLet. I agree to comply with all cdy and county
ordinances and slate laws relating to building construction, and BOILER-trf(3H.P.or 100,000 B.T.U.)(6A0�' PLUMBING
hereby mitIm,mentioned
ropertyforiins of This city In
enter upon the - BOILER-0OMP lover 100,000 BTU)SEE FEE SCH. / 40
abovrmemiurleJ property for inspection purposes. MECHANICAL
(we) agree to save, indemnify and keep harmless the City'of MISC.- REFER TO ORD.
uNdino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 1000 CONST.TAX
e1Wdi5jebf
sy way accrue against said City in consequence of the Q
this permit. MECH,CONT. LIC.NO. OMECTOTAL LCTOTAL
o(Applicant/Cnnlmd Or Umc /
OFFICE COPY